Archives for : January2016

Moral injury in civilian life: a new category of trauma

DSC00286To live in the United States today is to be constantly exposed to moral injury. Moral injury is not, however, equally distributed. Some people are vastly more injured than others, and some are not injured at all. Some people inflict moral injury on others. Lots of people are morally injured, and it is not always obvious.

One might argue that such a grand category, applying to so many, must result in pathologizing a normal experience. Moral injury may be normal, but it’s not good. The lives of the morally injured manifest in chronic sadness and despair, overlaying a rage that occasionally becomes dramatic.

From military trauma to everyday moral injury

Moral injury has become something of a hot topic among those who write about the trauma experienced by soldiers at war. So far, I can find nothing written about moral injury that applies to the experiences of civilians in everyday life. Yet, there is no reason it shouldn’t, particularly if it is interpreted properly.  Moral injury is the result of the use of  political power to deny the experiences of others. There is no more pernicious political power than this.

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Depoliticizing moral injury

B0000904Moral injury is a relatively new and puzzling category to the Department of Veterans Affairs, National Center for PTSD. Lots of researchers seem to recognize that it exists, but nobody can categorize it (Maugen and Litz). Or figure out an effective therapy for it, one that is evidence based, as they say, such as cognitive behavioral therapy (CBT), or prolonged exposure therapy (PE). The practical irrelevance of these therapies when dealing with moral injury makes moral injury a challenging category. 

Events are considered morally injurious if they “transgress deeply held moral beliefs and expectations,” as one of the first academic papers sponsored by the VA put it (Litz, et al., pp. 696, 700). A moral injury occurs when an act shatters the moral and ethical expectations of soldiers and others, including expectations about fairness, the value of life, and that leaders will tell the truth.

Though the publications of the VA recognize the existence of moral injury, it is not a currently accepted diagnostic category. One can receive recompense and treatment for PTSD, but not for moral injury, except on an experimental basis. Shame, guilt, and anger at the self or others’ betrayal of basic human values are central to moral injury. These emotions may occur with PTSD, but they are not key to its definition. PTSD is generally regarded as a fear-based disorder (in spite of DSM-5’s currently grouping it with dissociative disorders). Moral injury is guilt and shame based (Maguen and Litz, p. 2).

As I explain below, I think the VA has depoliticized what was originally a political concept.

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Trauma theory and Melanie Klein

B0000766Melanie Klein’s clinical researches on early childhood led her to postulate that the traumatic pathogenic situation par excellence is the overriding triumph of the death instinct. (Hernandez)

Trauma theory poses a problem for Melanie Klein, and Melanie Klein poses a problem for trauma theory. From a Kleinian perspective, the traumatic experience is not traumatic in itself. The traumatic experience is traumatic to the degree that it activates the fear of annihilation and destruction that is always waiting within, the haunting presence of the death instinct. The death instinct, in turn, gives rise to primitive defenses. Fearing death, the traumatized person projects his fear outward into persecutory objects and people, who then come back to haunt him.

A Kleinian theory of trauma in effect blames the victim. It is as though the Kleinian therapist said

Getting run over, almost dying, and spending six months in the hospital recovering isn’t the real source of your trauma. The real source of your trauma is the hate and aggression you feel toward what we call good objects, the people who really care for you. Your PTSD is so extreme right now because you fear you cannot protect the good from your own anger and hate.

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The lesson of trauma comes from its content, not form

B0000871The Sorrow of War: A Novel of North Vietnam, by Bao Ninh, is an important but not particularly well known literary trauma narrative.*  Ninh was a North Vietnamese soldier during the war.

The question I want to ask is what difference all the literary devices make, the devices that are supposed to make us feel the narrator’s trauma. Jane Robinett says they make all the difference in the world. I don’t think they make any difference at all. It’s an interesting question because much writing about literary trauma fiction focuses on the form, not the content, as though it is through the form that we can feel what the narrator feels.

Form or content?

Consider the following passage by Ninh, followed by its interpretation by Robinett.

Often in the middle of a busy street in broad daylight I become lost in a daydream. On smelling the stink of rotten meat I’ve suddenly imagined I was back crossing Hamburger Hill in 1972, walking over strewn corpses. The stench of death is often so overpowering I have to stop in the middle of the pavement, holding my nose, while startled, suspicious people step around me avoiding my mad stare. (Ninh, 46)

Robinett interprets.

The subtle shift in tenses (from present perfect to past and abruptly into present) in the middle of the paragraph moves readers directly into the experience just as the narrator abruptly finds himself reliving it. (Robinett, 297)

When I read the passage by Ninh it’s the content that counts, the way in which trauma intrudes on his postwar life. The shift in tenses doesn’t add much.

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Did literary trauma theory encourage the Iraq War?

B0000955Contemporary American Trauma Narratives, by Alan Gibbs (2014) is a fascinating book. Most provocative is Gibbs’ claim that a trauma theory perspective on 9/11 actually supported the Bush administration’s invasions of Iraq and Afghanistan. But I’ll get to that later.

The idea of analyzing literature from the perspective of trauma theory is still a little strange to me, even if I have analyzed narratives of the traumatized countless times. See my last post on Alice Sebold’s Lucky, an account of her rape. If I have been misled by Gibbs, or my own ignorance, I hope readers will correct me. *

Second hand trauma

A particularly troubling tendency in literary trauma theory is its claim that “authentic trauma fiction” enlists its

readers to become witnesses to these kinds of stories through the unconventional narrative translations of traumatic experience and memory that give them a different kind of access to the past than conventional frameworks . . . . when readers absorb these stories [like Beloved] through the division of voice . . . they experience something analogous to splitting. (Vickroy, 20, 27-28)

This makes no sense at all. There is no such thing as “something analogous to splitting.” With this claim we have entered the realm of “second-hand trauma.” (Gibbs, 29)

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